5) Medications, Diet & Science

Medications, Diet & Science

I couldn't decide what to write about next. Types of medications or what I was going to call science and the brain. Really they go hand in hand as the medications we currently have are based on what science has told us about the brain.
The first thing I learned about antipsychotic medications is that there are two types. Typical or first-generation and Atypical or second-generation. Typical are the ones that have been around since the 1950s. Atypical have been around since the 1990s. Because of the serious side effects of typical, Atypical were created to help lessen the side effects. However there currently seems to be a debate on whether or not they accomplished this.
Here's a list of typical antipsychotics:

Generic Name                   Brand Name                                                      
Chlorpromazine                 Largactil, Thorazine
Thioridazine                       Mellaril, Melleril, Novoridazine, Thioril
Mesoridazine                     Serentil
Levomepromazine             Nosinan, Nozinan, Levoprome
Loxapine                           Loxapac, Loxitane
Molindone                         Moban
Perphenazine                     Trilafon
Thiothixene                        Navane
Trifluoperazine                   Stelazine
Haloperidol                        Haldol
Fluphenazine                      Prolixin
Droperidol                         Droleptan, Dridol, Inapsine, Xomolix, Innover (+ Fentanyl)
Zuclopenthixol                   Clopixol
Prochlorperazine                Compazine, Stemzine, Buccastem, Stemetil, Phenotil

Here's a list of atypical antipsychotics:

Generic Name                   Brand Name
Amisulpride                        Solian
Aripiprazole                        Abilify
Asenapine                          Saphris
Blonanserin                        Lonasen
Clotiapine                            Entumine
Clozapine                            Clozaril
Iloperidone                        Fanapt
Lurasidone                          Latuda
Olanzapine                         Zyprexa, Ozace
Paliperidone                      Invega
Perospirone                       Lullan
Quetiapine                         Seroquel
Remoxipride                      Roxiam
Risperidone                        Risperdal, Zepidone
Sertindole                           Serdolect
Sulpiride                              Sulpirid, Eglonyl
Ziprasidone                        Geodon, Zeldox
Zotepine                              Nipolept

Under development:
Bifeprunox
Pimavanserin
Vabicaserin

I didn't realize there were so many. I wish that I had kept some of my old notes on some of the medications my son used to be on but I don't recall anything from the typical list. Also I apologize if I spelt any of them wrong. From the atypical list I'm aware of Aripiprazole, Risperidone, Olanzapine and Clozapine. Then there's also the anti-depressants and/or anti-anxiety medications. My son could probably give more information on those as I have not had to deal with them except when he first came back to live with me. Venlafaxine, Clonozapam and Lorazapam were the only three that I had to deal with. It was only recently that I realized Venlafaxine wasn't an antipsychotic.

Knowing the difference in generic and brand names has helped to cut down on some of the confusion I was going through when interacting with my son's psychiatrist and pharmacy staff. What I call Abilify his psychiatrist may call Aripiprazole. Same with Clozapine/Clozaril. It helps when I'm doing research or reading posts on forums to know that a drug with a different name is in fact the drug I'm looking for answers on.

Getting answers... Aside from the science part that I barely understand anyways, I find myself questioning a lot of what I read. I wonder about the study groups and what circumstances they are taking into account or not taking into account when they come up with results of something working or not working. For starters let me state that I would like to find a balance between medications and say the holistic approach of diet etc. but I do tend to lean on the side of medications at least for the moment. I do research on my son's medications and I read the side effects and yes I know that some of them can be quite serious. Weight gain, diabetes and tardive dyskinesia among the worst of them. I've previously made statements that I understand that my son doesn't want to take medications for something he thinks he doesn't have and that I can empathize with that. Well the fact is that he does have a mental illness. If I did have cancer I would do chemo therapy even knowing that it was going to cause some awful side effects because the possible benefits out way the negative side effects. I read a lot of people's concerns on side effects and the one thing that I seem to always end up questioning is 'How do we know that if left untreated the person in question would not have developed some of these effects anyways?' I ask it not to be uncaring but because I'm aware of how unhealthy a life a person with psychosis can lead. Tardive dyskinesia is scary but so is suicide. Per Wikipedia: Tardive dyskinesia is a form of  dyskinesia, a disorder resulting in involuntary, repetitive body movements. Frequently occurs after long-term or high-dose use of antipsychotics or in children and infants as a side effect from usage of drugs for gastrointestinal disorders. The involuntary movements are tardive, meaning they have a slow or belated onset. For me it raises the question of the possibility that tardive dyskinesia could have happened due to street drug use as much as prescribed antipsychotics. If they have slow or belated onset how can we be sure what's causing it. In trying to find my answers I end up asking a lot more questions. 

I guess this would bring me into the diet and science part. Every day more and more studies are being done. There are so many chemical imbalances, too much of this or too little of that. So many factors that were not being considered before.  He doesn't have enough niacin also known as vitamin B3, high levels of adrechrome an amino acid similar to adrenaline, not enough B6, zinc and vitamin C, could be sensitive to gluten especially wheat gluten and the list goes on.

As for science. There are so many theories yet still no definite answers. He has less grey and white matter, larger third and lateral ventricles yet less whole brain volume, decrease cerebral (cortical and hippocampal) volume, absence of gliosis and the list goes on and on. None of this makes a lot of sense to me. I do the research and look at the pictures in hopes that I will gain some understanding.  I found out about the larger third and lateral ventricles when I was trying to find a cause for the pressure my son reports feeling in his head. They are a communicating network of cavities filled with cerebrospinal fluid and located within the brain parenchyma... between the brain and his skull and are supposed to increase with age. Some of the abnormalities associated with the brain of someone with schizophrenia are: excessive stimulation of striatal dopamine (DA) D2 receptors, deficient stimulation of prefrontal DA D1 receptors and alterations in prefrontal  connectivity involving glutamate (GLU) transmission at N-methyl-d-aspartate (NMDA) receptors.  The simplest way I can understand all this is that my son's brain is over stimulated in some areas and the connecting areas are not able to handle the input. I would imagine it being like you're in a crowded room with everyone talking to you at once and your high or depressed to boot. 

Now try treating all this with diet. I don't think it's possible. I think it can help but as with everything else I just end up asking myself more questions. Is diet is going to decrease the size of his third and lateral ventricle, increase his grey and white matter or cause his striatal dopamine receptors to be less stimulated? I can try to limit his sugar so that he's not getting to stimulated, increase his niacin/vitamin B3 to help reduce hallucinations, give him vitamin C because he smokes so much, give him omega 3 because it's good for the brain and limit his gluten even though he doesn't have signs of celiac disease because it's not good for us. Very few of us eat a completely healthy diet and for the most part we aren't suffering from psychosis. I question if what is happening in the body is a result of what is happening in the brain or vice versa. I tend to believe that what is happening in the brain is causing the body not to function as it should. If the brain can't deal with all its internal stimuli how can it deal with bodily functions appropriately.  I'm happy he's eating and taking a multi-vitamin most of the time and for me that's good enough for now.

Back to medications and how they work. They help the brain to restore its usual chemical balance. They alter the activity of specific chemicals called neurotransmitters. Mental functions can be altered through the use of drugs either by speeding up or slowing down some of their activity. Caffeine is a psychoactive substance as are antipsychotic drugs. Antipsychotic drugs interfere in the functioning of several neurotransmitters and receptors. Dopamine and serotonin being some of them. Neurotransmitter receptors are found in the brain and the body. There is plenty of information on the internet on how they think antipsychotics work. Yes think... because even though they are creating them they don't seem to know exactly how they work just that they do work. They block dopamine receptors in one area of the brain that causes psychotic symptoms. They prevent norepinephrine and serotonin from being taken up into neurons after they have been released. I know little about dopamine and serotonin except that dopamine causes euphoria  and serotonin regulates our moods, appetite and sleep. If the brain is not regulating these properly then the result would be feeling too high or low and the inability to take care of our own body since it doesn't even know what it wants or needs. Combine this with what I wrote on delusions, etc. and here we are...  Can I expect to fix any of this without the aid of medications? I personally don't think so. I think I have said this before but the more stable I can get my son on antipsychotics the better I will be able to introduce to him a healthier life style and help teach him the right choices and the consequences of wrong choices.

Mom
BarbieBF

© August 2013

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